For many years, dentists, at the request of orthopedic surgeons, have provided antibiotics to patients with artificial joints. the thinking was that certain dental procedures introduce bacteria into the bloodstream and that bacteria could cause an infection in the prosthetic joint. An infected prosthetic joint is a very difficult complication to deal with and may require removal of the prosthetic joint, immobilization for months, intravenous antibiotics, and a new joint. It seemed justified to provide to a few antibiotics to prevent such a complication. The problem is the science was always murky and so we continued providing antibiotics based on a few unreliable case reports even though we thought the premise was a little suspect.
The same bacteria are introduced into the blood stream when you floss and possibly even when you eat. Nobody was taking antibiotics in these instances.
Well the recommendation to take antibiotics prior to dental treatment to prevent prosthetic joint infections has been discontinued.The recommendation from the American Dental Association now states, “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infections.” Supporting that change are 4 studies that looked at thousands of patients finding no correlation between dental appointments and prosthetic joint infections. In fact, one of the studies found that you are less likely to get a prosthetic joint infection if you don’t take antibiotics prior to dental appointments.
Taking antibiotics unnecessarily has risks. Antibiotic use is implicated in 75% of anaphylaxis or allergic reactions. 250,000 people are hospitalized each year resulting in 14,000 deaths with an intestinal infection called C difficile. This infection is generally associated with certain antibiotic use. Premedication cost US patients $50 million dollars each year.
There are certain conditions where pre-medicating with antibiotics is still warranted. Those patients are very small in number relative the number of patients that have been taking antibiotics.
In our practice, at Legacy Dental, in Salt Lake, our dentists look forward to working with patients and their orthopedic surgeons to decide on the best course of action to take great care of our patients as safely as possible.
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